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24B-066 (35) '21 q�' -0(IV GK P, �q MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY �� MA DATE J y L PERMIT# JOBSITE ADDRESS ( f AC ,/ / WNER'S NAME Mar. G . � OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL J PRINT CLEARLY NEW:V RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 6 7 8 9}. t - .. -11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER tIPPIOF FIREPLACE ':.�� , FRYOLATOR , i FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �f'YU,N 7�9L�N� LICENSE#�s�j Gi ATURE MP MGF JP JGF LPGI CORPORATIO�,Y'# <'f% PARTNERSHIP # LLC # COMPANY NAME: fGN �rJ G ADDRESS ��Z �� a: CITY �!✓�li�� / (;� .o STATEd. ZIPCS'. ._TEL` FAX CELL F �� FVIAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 CITY � ��/�7�/ '�.�'I' MA DATE J y' `` PERMIT# JOBSITE ADDRESSJCC _ Y OWNER'S NAME �,Pf�✓lard . . ��'=�.u` .�:+:�. OWNER ADDRESS TEL ' FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL RESIDENTIAL.,.;" - CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10- --1112 13 14 BOILER . BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE t r.. FRYOLATOR a FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ( NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY BOND ; OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. e 'OL PLUMBA-AER-GASFITTER NAME fifAN ,f .7,) 7�9LrJY� LICENSE# � Gfl MATURE MP MGF JP JGF LPG] CORPORATIO�, # f%% PARTNERSHIP # LLC # Q _ COMPANY NAME. f�(! - f�1 F/ C ADDRESS w� �� t ..:. I� ..::.:: / C'✓,. :u--:_:.:m . STATE��r ZIP O/ C1 CITY/ / / (,• T J TEL FAX CELL Y06WAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYly ( / / MA DATE J y' L `` PERMIT# JOBSITE ADDRESS �I J rC ._.�./ OWNER'S NAME UY►►,!O ? ...- k56- 0'.�,t OWNER ADDRESS TELT FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL, l EDUCATIONAL .w,,, RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT:. PLANS SUBMITTED: YES NO ' APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR ` GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHR� INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES \ NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY(�,' OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME ty i;►r� L�N/ LICENSE# �j ATURE MP X MGF JP JGF LPGI CORPORATIOO'# % PARTNERSHIP # LLC #i COMPANY NAME 1 15�JVX �„�e C ADDRESS�/z ;..._.l` ._ ...:. .... ... CITY r / STATE /WZI P / TEL N FAX CELL MAIL! MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK it CITY € /� MA DATE 1-4,"Z PERMIT# �./r ., x..> ..�., JOBSITE ADDRESSOWNER'S NAME T �0✓a Nati,��uL.w.�sSctG OWNER ADDRESS._..._.._._...._._._...._._..._....� ....._....__..._,_ w.. � TEL FAX= TYPE OR OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:$e RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES _ NO APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _. _ _.. ..._. BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTH §R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND C OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ��M AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �r'V LICENSE#' S(✓ . ATURE MP MGF JP JGF. LPGI CORPORAT105A*# C'f% CJ PARTNERSHIP #3 LLC #' COMPANY NAME:WJ�6) �ql- fC,14 �t"li C ADDRESS �... STATE CITY �!✓�,� / .�,. ✓7 ZIP -�../ :; FAX _ CELL �/"/ �r FAIL _.. _�.a. . :.u :. ..s..k_ � . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i /t/�/�JG��J MA DATE- L `` PERMIT# CITY JOBSITE ADDRESS OWNER'S NAME OWNER ADDRESS ` TEL' FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:e RENOVATION: REPLACEMENT: . PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _... BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OT,H�R,� _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES \ NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY c OTHER TYPE INDEMNITY BOND [' OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ' AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 61 AA I PLUMBER-GASFITTER NAME y1'Y �► N L�N� LICENSE# � ATURE . . _. �� 5 3 MP' ,' MGF JP JGFLPGI CORPORATIO # G % PARTNERSHIP,--#' LLC COMPANY NAME ADDRESS'� G�,C.. ,.:� f�i�P,�M:.: /L,'✓. _... . CITY W1j�/ STATEZIP .�.. ..,, . . TELu FAX CELL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ( �� /:�•' r' MA DATE -1"f" Z `` PERMIT# JOBSITE ADDRESS;a w 1 J�( � OWNER'SNAME OWNER ADDRESS TEL; FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL � RESIDENTIAL PRINT CLEARLY NEW:r RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY�- OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT I SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME '�r� �'�N.7.� -"J4�� LICENSE#75 ATURE MP X MGF JP JGF. LPGI CORPORATION`# e f i e PARTNERSHIP.—;#i LLC #_ COMPANY NAME �� -��•�1 �i C ADDRESS ! . CITY �1 ... STATE ZIP FAX CELL; MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' CITY ��/ . �J�'•'��µ....: ..0 MA DATE..�..� L PERMIT# JOBSITE ADDRESS , :w , � JCC ' / WNER'S NAME G � ..F OWNER ADDRESS ��. ...._.�__. .-.........................__._.._...._...._._._.._.�.�TEL _. FAX _.,._. TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH R _ C l)r INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME PJ ►„JV_`f'' �._ LICENSE# (3 ATURE MP MGF JP JGF7 LPGI CORPORATIO # f ii PARTNERSHIP # LLC # COMPANY NAME: f�/ c, l �"� C ADDRESS F L:,�_ CITY �!✓�� / G� STATE ZIP % TEL _ .Y... ._...T .. ...r CS .� FAX CELL ! �s AIL' _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK /. CITY �/j�i✓ 1'_.A7 MA DATE `f' L `` PERMIT# OWNER'S NAME JOBSITE ADDRESS. ~~` �i OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL ......i PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES ,... NO— APPLIANCES -1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0T,HH INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY�- OTHER TYPE INDEMNITY BOND I_ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER y AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 4,fAtA/ LICENSE# ATURE MP MGF JP'--' JGF LPGI CORPORATIOi� # Zf t ... PARTNERSHIP # LLC #; COMPANY NAME: �l - r1 �J C ADDRESS, .:: ? wa.,. .. a.:.._x.. . CITY STATEZIP TELk. ..�. �x.;..�._ ... . W FAX CELL; 1 AIL";_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ✓ / /� 1��w MA DATE J y" L `` PERMIT# JOBSITE ADDRESS g JCC ! � ... NAME ., Qq n OWNER ADDRESS TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL —- RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO`S APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH 7R _ M;-5 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I' j PLUMB ER-GASFITTER NAME T ��„N � L-'JY` LICENSE#; (� (1-41 ATURE MP� FMGF JP JGF LPGI CORPORATION' # G's% CJ PARTNERSHIP # LLC # �7 l 77 - COMPANY NAME : / / .. �1`IFI..G ADDRESS,, GAP. ..._._ .. .m. .��.,. CITY �_�/ �� STATE i�ZIP 0#�C TEL FAX. ' CELL 1 �� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I � /'�•'�' MA DATE J .. 1 9 - L `` PERMIT# JOBSITE ADDRESS' � � .v�,,. ,� � OWNER'S NAME OWNER ADDRESSTEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ✓'�' RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: . PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OT,HR INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1( NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement, CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ��— PLUMBER GASFITTER NAME ��'V `1�N ��Lrh'� LICENSE#; ( XC ATURE _. MP7V MGF JP JGF LPGI CORPORATIO� '# f%% PARTNERSHIP # LLC #' COMPANY NAME: /"i_ C ADDRESS �' f �.E�„ /�-;!✓ ..w _._._ .x _.._. .moi CITY / STATE iZIP ... / TEL i _/ . � _ .._._., .A._ .......__M FAX CELL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK a .. Y>> CITY [ � .� MA DATE= "-2 `` PERMIT# ; JOBSITE ADDRESS. o�. JCC / OWNER'S NAME OWNER ADDRESS TEL !FAX. . ,,. _ TYPE OR OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:SL RENOVATION: REPLACEMENT: ; PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER m FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTH, R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW \\ LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY BOND SLµ;,•, OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ __. PLUMBER GASFITTER NAME1'Y ��, AA- � ��L"N� LICENSE#�(J ATURE MP MGF JP x JGF _ LPGI CORPORATIO��'# G'f% C> PARTNERSHIP # LLC #. COMPANY NAME: f - �rl .. �`!.C ADDRESS / CITY / STATE e�'ZIP / c TEL FAXCELLieMAIL! MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY �J�� MA DATE i y' L <` PERMIT# JOBSITE ADDRESS'_ _ WNER'S NAME kL GOWNER ADDRESS „ TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY -- "�'� -- NEW:X RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OT,HR INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY�- OTHER TYPE INDEMNITY BOND L_ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAMELICENSE# GI ATURE MP ry 0011 MGF JP JGF LPGI CORPORATI01 # Zf ii1 PARTNERSHIP # LLC # � COMPANY NAME: ,f /�1 - �N.. l c ADDRESS,/ .. . ,.�., __..�.._� -meq CITY �!✓��%�� (,� STATE; Ir71ZIP Or xTEL ......... FAX CELL, I O(AIL' .. � � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK J/ CITY .. _.�.,.,� MA DATE� y PERMIT# JOBSITE ADDRESS' r--� u � OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONAL RESIDENTIAL ' PRINT , CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NOS. APPLIANCES Z FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER — BOOSTER _ . CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ,. I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND L OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. AA- , PLUMBER-GASFITTER NAMELICENSE# rATURE .:... MP X, MGF JP J G F _ LPGI CORPORATION` # ?f// 'J� PARTNERSHIP # LLC # COMPANY NAME ✓. ' -:!.- �...� ADDRESS. . ..�. - G�, ... ._. � .M .� .... CITY �� ` -14 STATE4ZIP .:. TEL FAX CELL,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY /%� / MA DATE€ PERMIT# � ' � ..L . JOBSITE ADDRESS' ? ` OWNER'S NAME OWNER ADDRESS :` TEL ,FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY _.. NEW. RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch,142 YES ! NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW Lt LIABILITY INSURANCE POLICY' OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I- AL PLUMBER GASFITTER NAME � _..._��irN ��ft� LICENSE#3,5 ; AATURE MP M G F JP JGF LPGI CORPORATION# t�f% V PARTNERSHIP # LLC #; /.. _ COMPANY NAME: N �J..0 ADDRESS /' .L..�., ..:::._.! ._ ...� ., CITY fi ,�/ STATEZIP 'TEL .... m n.. m �. . �. .�.._. FAX CELL, i T62 AIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY •....� MA DATE;.......... PERMIT# JOBSITE ADDRESS OWNER'S NAME OWNER ADDRESS TEI FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0T,HR INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1 NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY c OTHER TYPE INDEMNITY BOND _ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �y PLUMBER GASFITTER NAME '�N LICENSE ATURE MP MGF JP JGF LPGI CORPORATIOi> # Z f% PARTNERSHIP # LLC':'---':#' COMPANY NAME: f��l '� rcLP _,�?7p! C ADDRESS l ' �i .. CITY i� STATE' ZIP �/ t7�/�', TEL i= FAX CELL gi 0 AIL' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ! � / �/�iV MA DATE,/- ' L `y PERMIT# T� JOBSITE ADDRESS"_ ! OWNER'S NAMEC , OWNER ADDRESS TEL; "FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL; EDUCATIONAL RESIDENTIAL •"- CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER,,,,,_, _0TH R 7TH R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES \ NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 6r PLUMBER GASFITTER NAME �'Vi�l�/ L-�N/ , LICENSE# 1(� ATURE MP MGF JP JGF LPGI CORPORATION# 10 PARTNERSHIP # LLC # COMPANY NAME: �,l �- c�il �r� C ADDRESS/Z i;� CITYSTATE TEL �!✓�fi / wM� %r�ZIP FAX :: . » ._ CELL G)WA:= ' AIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE " L `= PERMIT# JOBSITE ADDRESS +^ OWN 'S NAME .l -.. .a' t.1 d /p- OWNER ADDRESS TELA FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ! RESIDENTIAL PRINT .. CLEARLY NEW:$` RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _.... BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTH R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES .NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY�- OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME , N ��.N 7,AL�N LICENSE# (j ATURE MP MGF JP JGF LPGI CORPORATION # t�f ii PARTNERSHIP # LLC # _. COMPANY ADDRESS CITY �t�'� %/�/ ( STATE^ ZIP e/ TEL .,. FAX CELL: u . " 'v'AIL =- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ��✓ T/ ...,i T=�'`w MA DATE _, . .`� L' PERMIT# JOBSITE ADDRESS J1C / OWNER'S NAME ' ► Imo,�_t_ per, GOWNER ADDRESS TEL FAX: TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ~ ' RESIDENTIAL -- CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES ._ NO ' APPLIANCES-1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER ..... .....:...... . . OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ` AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME co.NALICENSE ATURE MP X MGF JPJGF LPGI CORPORATIO1 A'# of// PARTNERSHIP # LLC 74i COMPANY NAME: cC,,' i C ADDRESS CITY � �(,� STATEj ZIP �/ �7�� .. TEL 1 L �� FAX CELL �: AIL e MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 7&;V�� MA DATE 7....... PERMIT# JOBSITE ADDRESSJu �`� � ,�/ OWNER'S NAME OWNER ADDRESS _ :TEL FAX — TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL - RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER . 0TH R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES \ NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY�- OTHER TYPE INDEMNITY BOND Via, OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME '��'`� C►rN LICENSE# AlGflATURE .. MP . MGF JP JGFµ LPGI CORPORATIO��'# �!ii CJ PARTNERSHIP # LLC # COMPANY NAME -�G l /"�: C ADDRESS z 0 t i; 'r*7'; /00 CITY STATE ZIP / TEL FAX CELL ki I L' ��L'6-PAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,.� CITY MA DATE � PERMIT# JOBSITE ADDRESS OWNER'S NAME OWNER ADDRESS TEL FAX OCCUPANCY TYPE COMMERCIAL; TYPE OR PRINT OMMERCIAL;�_ EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES N0 '' APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR -- -- — - FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0THR INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY( OTHER TYPE INDEMNITY BOND f> OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. t� PLUMBER GASFITTER NAME )A- 1--"WI LICENSE# �,J� /MATURE MP MGF JP t JGF _ ; LPGI- CORPORATI01� # % PARTNERSHIP,,,,,—# LLC # COMPANY NAME: f / �- ��'1.. �1 C ADDRESS F�Z l :.� �i_ .:M,..!"✓.. . _ CITY �1 /� �M::ra. ..-µ.��•aab,� .,,,>..,,x.. STATE ZIP M� �., TELM,_�. .� FAX CELL ... AILx.. x . �v... .'. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r CITY � �Jre��t/'. MA DATE'. Z q ' L `d PERMIT# .... _. JOBSITE ADDRESS / OWNER'S NAME ] OWNER ADDRESS TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT:w PLANS SUBMITTED: YES . . NO APPLIANCES 7 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTH R IL INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY�- OTHER TYPE INDEMNITY BOND �;•• OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAMEf'� LICENSE#.,7' ATURE _....� MP MGF JP JGF LPGI CORPORATIOf ,Y'# ZJ . _ PARTNERSHIP # LLCM COMPANY NAME .,f ° ' 1 C _ ADDRESS,/ � _ CITY >>�� l STATE' ZIP JTEL .. . FAX , CELL AIL' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE 7 L `` PERMIT# JOBSITE ADDRESSw OWNER'S NAME GOWNER ADDRESS :TELA FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL ` RESIDENTIAL - CLEARLY NEW:$4 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND F—' OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. —_ CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME T ,f,4; C)'A4 LICENSE# ,7 ATURE MPTV MGF JP JGF• LPGI CORPORATIO��'# PARTNERSHIP # COMPANY NAME. -Th ADDRESS CITY / STATE' ZIP / �'''`'"" TEL FAX CELLiAIL', MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ?/y,� ! ��=% _.... MA DATE! ' L ` PERMIT# JOBSITE ADDRESS' J1( .� Af � OWNER'S NAME OWNER ADDRESS TEIJ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL M RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OT R _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ��71'Y LIrN 7 L N� LICENSE# (j ATURE MP" MGF JP JGF LPGI CORPORATION# PARTNERSHIP #i LLC #.COMPANY NAME: ADDRESS : kZIP , TELCITY STATEAr �. _.. FAX: CELL ) 7rr AIL' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ... MA DATE J4 PERMIT# JOBSITE ADDRESS a� / OWNER'S NAME t t G ___.. OWNER ADDRESS TELA ___ 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:t(C_ RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE — GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER...... OTHR _ _ /'��' ��,..�''.� syr•?l INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME r'vQ A4 ��L-"Nf LICENSE# f ATURE MP, MGF JP JGF LPGI CORPORATIO��'# G�f% t) PARTNERSHIP # LLC # 1 COMPANY NAMEfj -,. �1 i C ADDRESS 4UlK Z_ ZIP �f %� CITY Gc! :: F:� .� � _... STATED .:TEL FAX CELL; AIL' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY .... MA DATE 7 ': PERMIT# OWNER'S NAME JOBSITE ADDRESS _ J�( �.,.:Q OWNER ADDRESS TELT FAX' ...xrwzrx.:..,.....:�u-s....m�xauxur.xa::.. .usna:-xxww..avrrr:urwrcx ,.. _s.--.z.- .r.�:. 4.waa_:.;:.:__., uawaa:......:.an»:.w....... ...........^^�'�-'�..�'�...•. TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL ' RESIDENTIAL `. CLEARLY NEW:$e RENOVATION:!ry ., REPLACEMENT: --- PLANS SUBMITTED: YES NO APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE ................ DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTIJ�R _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY(- OTHER TYPE INDEMNITY BOND ,, OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �'�! ��rN L,�/Y� LICENSE#, ,AIGNATURE MPWIN MGF JP JGF LPGI CORPORATI01 # Zr-f PARTNERSHIP # LLC # ��u.. COMPANY NAME: f��f - cr.. 1 �Pl C ADDRESS �� ...� ..:� < .. .. : ..... .:x. CITY !�'�f/ �G� STATE r ZIP TEL, FAX CELL i > �� WAIL' _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r" CITY / MA DATE ' L `` PERMIT# JOBSITE ADDRESS , � �� R�i'.=.. 1. OWNER'S NAME S G _. OWNER ADDRESS TEL FAX. TYPE OR OCCUPANCY TYPE COMMERCIAL, l EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _.. BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH R 9 C vi INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND ,,,,,w OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME ... ► N �,�L-��/ LICENSE ATURE MP MGF JP JGF LPGI CORPORATIO1� # Z f/ PARTNERSHIP # LLC # COMPANY NAME _... � ..r�Pi C ADDRESS CITY � !��.. STATEM!ZIPY._..��.. TEL FAX i CELL fl AIL; MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK [ CITY MA DATE 7 ' � `�' L `` PERMIT# JOBSITE ADDRESS o 1u / OW R'S NAME ^ OWNER ADDRESS TEL FAX' TYPE OR OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL x RESIDENTIAL PRINT - CLEARLY NEW: RENOVATION: REPLACEMENT:'— PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _... . BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHH / ` _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch, 142 YES l NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY c OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER !, AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. L;_ PLUMBER GASFITTER NAME' , LICENSE � ATURE MP MGF JP JGF LPGI CORPORATI01�# ��) PARTNERSHIP # LLC # COMPANY NAME: f��J f} ��14 .. %'� C ADDRESS; Z 0 CITY WV/ (W.V STATEdZIPTELI FAX � e CELL] )�/06- TAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE-' (' L `` PERMIT# JOBSITE ADDRESS J1C r---. <..� �� -. OWNE SNAME ,::Z _-�_-- OWNER ADDRESS ' TES FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL ' CLEARLY NEW:IV RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES No— APPLIANCES 7 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OT,HI-R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES \ NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY�- OTHER TYPE INDEMNITY BOND It OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER '' AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME , �ry `►„N LICENSEr# s�j ATURE MP MGF JP's JGF LPGI CORPORATIO1 A'# C�f% CJ PARTNERSHIP #_ LLC; COMPANY NAME: �� ql- � i �i C ADDRESS Z 0 � t� CITY / STATEZIP ... TEL FAX CELL ) F AIL! MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY �� / ��1'�•'y' MA DATE J y L `` PERMIT# JOBSITE ADDRESS,_ �>� c�� / . OWN R'S NAME GOWNER ADDRESS TEL - FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ,.- RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES N0 ` APPLIANCES -1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW \ LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY B 0 N D a: i OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME AAir ,�� or Cp � _ �-"JY}`�' LICENSE#�f(,j ATURE MP MGF JP JGF LPGICORPORATIOf # Gi f% 1r) PARTNERSHIP # LLC # COMPANY NAME- CITY AME ,/�/9✓!' '7L-,/�dI �l C ADDRESS_ CITY �` i" STATE)dZIP / �� TEL FAX CELL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY / .. . �'"J-�e .... _._... MA...DATEi �,.i� ..Lµ� PERMIT# JOBSITEADDRESS' All _ 5 !NER'SNAME OWNER ADDRESS TEL fAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES-1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER .......... _..._ 0TH R _ " 't %, —A IL INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �i PLUMBER GASFITTER NAME LICENSE# f(j ATORE MPMGF JP_.... JGPC, F LPGI CORPORATION# G�f ii PARTNERSHIP # LLC # w.. COMPANY NAME: f�� '91' �f`I C ADDRESS c�,.Ct?• :.. _A0 _._.. c _. CITY I!I� STATE i�ZIP TEL` FAX CELL, 1 r•. AIL '